Basic Information
| Provider Information | |||||||||
| NPI: | 1811497043 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WASHINGTON UNIVERSITY PHYSICIANS IN ILLINOIS, INC. | ||||||||
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| OtherOrganizationName: | WUPI - ANESTHESIOLOGY | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4240 DUNCAN AVE STE 301 | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631101123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3142730770 | ||||||||
| FaxNumber: | 3142730470 | ||||||||
| Practice Location | |||||||||
| Address1: | 4500 MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | BELLEVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622265360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147473581 | ||||||||
| FaxNumber: | 3147471710 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2018 | ||||||||
| LastUpdateDate: | 03/05/2018 | ||||||||
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| AuthorizedOfficialLastName: | EGHIGIAN | ||||||||
| AuthorizedOfficialFirstName: | CATHY | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR, CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 3142730770 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.